Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | C.1902396 | OH |
NPI | 1003370578 |
---|---|
Provider Name | Jacklyn Ewald |
First Address | Dayton, OH 45417 |
Second Address | Dayton, OH 45417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2019 |
Last Update Date | 01/07/2020 |